Adolescent Pregnancy and Parenting: Reducing Stigma and Improving Outcomes

BOOK REVIEW

Adolescent Pregnancy and Parenting: Reducing Stigma and Improving Outcomes

Edited by Jean-Victor P. Wittenberg, MD, FRCPC; Daniel F. Becker, MD; Lois T. Flaherty, MD; Springer, 2023

180 pages; $99.99 (paperback)

Reviewed byDana Hardin, MD

Teen pregnancy is often viewed through a very negative lens. As a society, we frequently view teen pregnancy as a failure in parenting, not only by the parents of the pregnant teen, but also as an inevitable failure by the teen of her future child. The book Adolescent Pregnancy and Parenting: Reducing Stigma and Improving Outcomes—edited by Jean-Victor Wittenberg, MD, FRCPC; Daniel Becker, MD; and Lois T. Flaherty, MD—does a very nice job of challenging these preconceived notions. This review will discuss the book and present additional insights from an interview with Dr Flaherty. It is a must read for psychiatric providers of teens.

Chapter one, “Epidemiology, Trends, and Public Policy,” provides important information regarding personal and family factors, as well as societal factors, which increase the risk for teens to become pregnant. As discussed in this chapter, personal and family factors are at times complex but can be systematically addressed. Societal factors contribute to the personal issues which affect families of teens, and thus are the tipping point that increases the risk for a teen to become pregnant. The chapter provides examples of societal issues contributing to teen pregnancy and demonstrates the need for change in public policy.

Throughout this book, there is a heavy focus on stigma surrounding teen pregnancy and each chapter contains useful information on this topic. Sources of stigma are at times surprising. One would expect school encounters from peers to likely be problematic, but teachers and other school officials also contribute to stigma. Beyond school, there are examples of stigma in simple daily encounters, such as shopping. These examples reveal the pervasiveness of stigma against teen pregnancy and the apparent perceived license the public has in letting their opinions be known even when not solicited. As one would expect in today’s culture, social media is a major source of stress for pregnant teens and teen mothers. In many of these situations, these young women are not able to speak up for themselves. The internalization of stigma is found to be one of the most important sources of poor outcome for young teen mothers. There is also a chapter describing the effects of stigma on children of teen mothers. The negative outcome of stigma in children of teen mothers provides even greater impetus for society to change. Instead of condemning these young individuals, we need to focus on making the future hospitable.

Substance abuse is an understandable risk factor for teen pregnancy and as such, there is an entire chapter dedicated to discussing substance abuse. The chapter enlightens readers on factors which contribute to substance abuse and the ways risk factors leading to substance abuse coincide with risk factors of teen pregnancy. As discussed, there is more than just the impulsive decisions which are often made when under the influence of substance. Interestingly, there is a good discussion on how pregnancy can be a helpful influence for these women to overcome addiction. In addition to substance abuse, there is an excellent chapter discussing other mental health disease presenting in pregnant teens.

One of the most eye-opening chapters, “Voices of Lived Experiences,” provides quotes and examples of life experiences from teen mothers. These women describe points they considered when deciding to deliver and keep their babies. They also discuss the ups and downs of living with their children. They provide examples of stigma they faced and the stress the stigma caused. Importantly, they reveal their reactions to stigma and stress. These examples provide insight into personality traits, allowing some of the mothers to grow stronger and to parent successfully. As one would imagine, one of the very important factors of success is personal attachment and support. Of special note, significant positive attachment does not have to be only from family. The young women talk about various sources of help and inspiration, including health care providers. These examples are particularly helpful for psychiatric providers who are called upon to care for young mothers and can be a road map for clinicians. The chapter on teen fathers provides complimentary insight into male factors contributing to teen pregnancy. In the chapter “Interventions Supporting and Empowering Pregnant and Parenting Adolescents,” the reader learns of policies that have worked in helping young mothers, such as efforts to keep young women in school. Examples of interventions from charitable and religious groups could potentially inspire additional help. This chapter is especially important for psychiatric providers as we are often called upon to affect change in a patient’s thinking and environment.

Discussion w/ Dr Flaherty

Over the course of 60 minutes, I had the pleasure of interviewing Dr Flaherty about this book. Our interview felt far too short as Dr Flaherty expanded on the subjects discussed in the book.She further discussed topics such as the influence of health care policy, religion, and social media on pregnancy outcomes. She had much wisdom to share.

Dr Flaherty is a soft-spoken woman who has had long career treating psychiatric disorders. Throughout our interview, it was quite clear that she clearly has a passion for providing care and understanding psychiatric issues in teens. She was one of the early members of the American Society of Adolescent Psychiatry and is a former president. She discussed the origins of this book as a follow-up to an earlier book published in the 1970s by Dr Flaherty and the coeditors of this book. They were early members of the adolescent psychiatric subgroup of the American Psychiatric Association and recognized the importance of teen pregnancy as a life altering event which impacted future development and the psyche of young women. Over the past few years, this group realized that the current outcomes of teen pregnancy are not as devastating as the outcomes documented in their earlier publication. Around the same time, Dr Flaherty became acquainted with a young woman, a former teen mother, who clearly demonstrated positive outcomes for both mother and child. She said the book came together as “a sort of confluence of these events” to highlight the need for this group of colleagues to revisit the topic of teen pregnancy.

Here is a final quote from Dr Flaherty: “Teen motherhood does not have to mean a lifetime of disadvantage for adolescents and their children. In fact, when compared with young women in similarly disadvantaged circumstances who do not become mothers, teen mothers actually do better than their peers. Most teen pregnancy is unintended and occurs in the context of complex social and emotional factors. With appropriate support from families and professionals, teens who choose to have their babies can be successful parents and well-functioning adults. Psychiatrists who see adolescents will inevitably see young parents-we need to think about our own attitudes and how we can best support them and avoid further stigmatizing them.”

Dr Hardin is a psychiatrist in Columbus, Ohio, and currently serves as vice president for the American Society for Adolescent Psychiatry.